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Li B, Li H, Huang Q, Zheng Y. Shaping the Future of Behçet's Uveitis Management: A Comprehensive Review of Efficacy, Challenges, and Prospects of Biologic Therapies. Ophthalmol Ther 2023; 12:2295-2321. [PMID: 37477857 PMCID: PMC10442050 DOI: 10.1007/s40123-023-00767-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/29/2023] [Indexed: 07/22/2023] Open
Abstract
Behçet's uveitis (BU), a vision-threatening manifestation of Behçet's disease, poses substantial management challenges due to its chronic, relapsing nature and potential for vision loss. This review explores the role of biologic therapies in the treatment of BU, providing a comprehensive overview of their effectiveness, drawbacks, and future possibilities. Traditionally, management has relied heavily on corticosteroids and conventional immunosuppressants. However, their long-term use is frequently associated with systemic side effects and insufficient control of ocular inflammation. Biologic therapies, particularly TNF-alpha inhibitors like infliximab and adalimumab, have emerged as effective alternatives, offering better disease control and a more favorable safety profile. We critically evaluated these agents, noting their clinical efficacy in reducing inflammatory flares and preserving visual acuity. Despite their benefits, several issues remain. Accessibility, cost, and lack of long-term safety data limit their widespread use. Additionally, individual variability in treatment response necessitates personalized therapeutic strategies. Recent research has shown promise in addressing these challenges, with the emergence of novel biologic agents and personalized medicine approaches. In summary, biologic therapies represent a paradigm shift in BU management, contributing to better patient outcomes. Yet, there are significant challenges to be overcome. As we move forward, continued research, development of novel biologic agents, and a precision medicine approach will shape the future landscape of BU treatment.
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Affiliation(s)
- Biao Li
- Department of Ophthalmology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Haoran Li
- Department of Ophthalmology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Qun Huang
- Department of Ophthalmology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Yanlin Zheng
- Department of Ophthalmology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China.
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Pillai MR, Balasubramaniam N, Wala N, Mathews AM, Tejeswi B, Krishna H, Ishrath D, Rathinam SR, Sithiq Uduman S M. Glaucoma in Uveitic Eyes: Long-Term Clinical Course and Management Measures. Ocul Immunol Inflamm 2023:1-7. [PMID: 37140329 DOI: 10.1080/09273948.2023.2202740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND The management of glaucoma in uveitis is challenging. A meticulous combination of anti-glaucoma and anti-inflammatory agents is often needed to control the intraocular pressure (IOP) and preserve the visual status in an otherwise blinding disease. AIM To study the clinical course and management of glaucoma in uveitic eyes. METHODS A retrospective study analyzing the case records of patients over 12 years, referred for the management of uveitic glaucoma in the last two decades. RESULTS The analysis of 582 uveitic glaucoma eyes of 389 patients was done, and the mean IOP at baseline was 25.89 (±13.1) mmHg. Non-granulomatous uveitis (102 eyes) was the most common diagnosis. Granulomatous uveitis was the most common diagnosis among the treatment failure eyes and in eyes requiring more than one surgical intervention for glaucoma. CONCLUSION An appropriate and adequate combination of anti-inflammatory and IOP-lowering therapy will lead to better clinical outcomes.
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Affiliation(s)
- Manju R Pillai
- Glaucoma Services, Aravind Eye Care System, Madurai, India
| | | | - Narendra Wala
- Glaucoma Services, Aravind Eye Care System, Madurai, India
| | | | - Beeram Tejeswi
- Glaucoma Services, Aravind Eye Care System, Madurai, India
| | - Harini Krishna
- General Ophthalmology, Aravind Eye Care System, Madurai, India
| | - Deeba Ishrath
- Glaucoma Services, Aravind Eye Care System, Madurai, India
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Vitale A, Caggiano V, Berlengiero V, Perfetti MO, Sota J, Tosi GM, Frediani B, Cantarini L, Fabiani C. Comparing biologic options for the management of Behcet's disease-related uveitis. Expert Rev Clin Immunol 2023; 19:315-328. [PMID: 36715297 DOI: 10.1080/1744666x.2023.2174103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Behçet's disease (BD) associated uveitis occurs in approximately 50-70% of the patients. Ocular involvement in BD may induce a severe affection of visual function, leading to a considerable decrease in patients' quality of life. The risk for severe visual loss increases when the ocular posterior segment is involved and in patients with no adequate treatment. AREAS COVERED Monoclonal tumor necrosis factor (TNF) biotechnological inhibitors represent a relatively recent milestone for the treatment of non-infectious uveitis (NIU) also in BD patients. In addition to TNF inhibitors, further biologic agents have been increasingly proposed for multi-recalcitrant cases, as for interleukin (IL)-1 and IL-6 inhibitors. However, evidence on these new opportunities requires to be widened in the next future. EXPERT OPINION Joining the forces for scientific efforts is essential to quickly obtain solid acquisitions useful for the everyday clinical practice. To this end, the Auto-Inflammatory Disease Alliance (AIDA) Network has recently supported the development of an international registry dedicated to NIU and other inflammatory ocular involvement observed in BD patients. This will be essential to resolve current and future unmet needs burdening the everyday clinical practice.
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Affiliation(s)
- Antonio Vitale
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Valeria Caggiano
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Virginia Berlengiero
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Maria Orsetta Perfetti
- Ophthalmology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Jurgen Sota
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Gian Marco Tosi
- Ophthalmology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Bruno Frediani
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Luca Cantarini
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Claudia Fabiani
- Ophthalmology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
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Gómez-Gómez A, Madrid-Garcia A, Borrego-Sanz L, Álvarez-Hernández P, Arriola-Villalobos P, Pérez-Sancristobal I, Benítez Del Castillo JM, Mendez-Fernandez R, Pato-Cour E, Díaz-Valle D, Rodriguez-Rodriguez L. Therapeutic Response After Immunosuppressive Drug Prescription in Non-infectious Uveitis: A Survival Analysis. Ophthalmol Ther 2023; 12:139-153. [PMID: 36266560 PMCID: PMC9834496 DOI: 10.1007/s40123-022-00587-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/23/2022] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION To identify factors affecting the response rate to immunosuppressive drugs (ISDs) in patients with non-infectious uveitis (NIU). METHODS This longitudinal retrospective cohort study included patients from the Hospital Clinico San Carlos Uveitis Clinic diagnosed with NIU from 1992 to 2016. Subjects were followed up from ISD prescription until the achievement of good therapeutic response (GTR), ISD treatment change, or up to 12 months. GTR was defined as the complete resolution of the eye inflammatory manifestations with a corticosteroid dose ≤ 10 or ≤ 5 mg per day of prednisone or equivalent (GTR10 and GTR5, respectively) maintained for at least 28 days. Kaplan-Meier curves were estimated for GTR. Demographic, clinical, and treatment-related factors were analyzed using Cox robust regression. RESULTS A total of 73 patients (100 episodes of ISD prescription) were analyzed. In 44 and 41 episodes, GTR10 and GTR5 were achieved, respectively. A lower hazard for both GTRs was associated with uveitic macular edema at prescription and with a higher "highest oral corticosteroid dose prescribed in the year before ISD prescription". GTR10 was higher if cyclosporine was prescribed (compared to other ISDs), and if a higher number of ISDs had been previously prescribed. GTR5 hazard was lower for patients with posterior uveitis or if the ISDs were prescribed before 2008, and higher if periocular corticosteroids had been administered before ISD prescription, or if the duration of the posterior segment activity was shorter. CONCLUSIONS Factors associated with GTR to ISDs may help to identify patients with NIUs who could benefit from a thorough follow-up.
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Affiliation(s)
- Alejandro Gómez-Gómez
- School of Medicine, Universidad Complutense de Madrid, Plaza Ramón y Cajal, s/n, 28040, Madrid, Spain
- Rheumatology Department, Hospital Universitario Vall d'Hebron, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain
| | - Alfredo Madrid-Garcia
- Musculoskeletal Pathology Group, Rheumatology Department, Health Research Institute (IdISSC), Hospital Clínico San Carlos, c\ Prof. Martín Lagos, s/n, 20840, Madrid, Spain
| | - Lara Borrego-Sanz
- Ophthalmology Department and Health Research Institute (IdISSC), Hospital Clínico San Carlos, Calle Prof. Martín Lagos s/n, 28040, Madrid, Spain
| | - Paula Álvarez-Hernández
- Rheumatology Department and Health Research Institute (IdISSC), Hospital Clínico San Carlos, Calle Prof. Martín Lagos s/n, 28040, Madrid, Spain
| | - Pedro Arriola-Villalobos
- Ophthalmology Department and Health Research Institute (IdISSC), Hospital Clínico San Carlos, Calle Prof. Martín Lagos s/n, 28040, Madrid, Spain
| | - Inés Pérez-Sancristobal
- Rheumatology Department and Health Research Institute (IdISSC), Hospital Clínico San Carlos, Calle Prof. Martín Lagos s/n, 28040, Madrid, Spain
| | - José M Benítez Del Castillo
- Ophthalmology Department and Health Research Institute (IdISSC), Hospital Clínico San Carlos, Calle Prof. Martín Lagos s/n, 28040, Madrid, Spain
| | - Rosalía Mendez-Fernandez
- Ophthalmology Department and Health Research Institute (IdISSC), Hospital Clínico San Carlos, Calle Prof. Martín Lagos s/n, 28040, Madrid, Spain
| | - Esperanza Pato-Cour
- Rheumatology Department and Health Research Institute (IdISSC), Hospital Clínico San Carlos, Calle Prof. Martín Lagos s/n, 28040, Madrid, Spain
| | - David Díaz-Valle
- Ophthalmology Department and Health Research Institute (IdISSC), Hospital Clínico San Carlos, Calle Prof. Martín Lagos s/n, 28040, Madrid, Spain
| | - Luis Rodriguez-Rodriguez
- Musculoskeletal Pathology Group, Rheumatology Department, Health Research Institute (IdISSC), Hospital Clínico San Carlos, c\ Prof. Martín Lagos, s/n, 20840, Madrid, Spain.
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Takeuchi M, Usui Y, Namba K, Keino H, Takeuchi M, Takase H, Kamoi K, Hase K, Ito T, Nakai K, Maruyama K, Kobayashi E, Mashimo H, Sato T, Ohguro N, Hori J, Okada AA, Sonoda KH, Mizuki N, Goto H. Ten-year follow-up of infliximab treatment for uveitis in Behçet disease patients: A multicenter retrospective study. Front Med (Lausanne) 2023; 10:1095423. [PMID: 36744150 PMCID: PMC9894869 DOI: 10.3389/fmed.2023.1095423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/05/2023] [Indexed: 01/21/2023] Open
Abstract
Purpose To evaluate 10-year outcome of infliximab (IFX) treatment for uveitis in Behçet disease (BD) patients using a standardized follow-up protocol. Design Retrospective longitudinal cohort study. Participants 140 BD uveitis patients treated with IFX enrolled in our previous study. Methods Medical records were reviewed for demographic information, duration of IFX treatment, number of ocular attacks before IFX initiation, best corrected visual acuity (VA) at baseline and 1, 2, 3, 4, 5, and 10 years after IFX initiation, uveitis recurrence after IFX initiation and main anatomical site, concomitant therapies, and adverse events (AEs). Main outcome measures 10-year IFX continuation rate and change in LogMAR VA. Results Of 140 BD patients, 106 (75.7%) continued IFX treatment for 10 years. LogMAR VA improved gradually after initiation of IFX, and the improvement reached statistical significance from 2 years of treatment. Thereafter, significant improvement compared with baseline was maintained until 10 years, despite a slight deterioration of logMAR VA from 5 years. However, eyes with worse baseline decimal VA < 0.1 showed no significant improvement from baseline to 10 years. Uveitis recurred after IFX initiation in 50 patients (recurrence group) and did not recur in 56 (non-recurrence group). Ocular attacks/year before IFX initiation was significantly higher in the recurrence group (2.82 ± 3.81) than in the non-recurrence group (1.84 ± 1.78). In the recurrence group, uveitis recurred within 1 year in 58% and within 2 years in 74%. Seventeen patients (34%) had recurrent anterior uveitis, 17 (34%) had posterior uveitis, and 16 (32%) had panuveitis, with no significant difference in VA outcome. In addition, logMAR VA at 10 years did not differ between the recurrence and non-recurrence groups. AEs occurred among 43 patients (30.7%), and 24 (17.1%) resulted in IFX discontinuation before 10 years. Conclusions Among BD patients with uveitis who initiated IFX, approximately 75% continued treatment for 10 years, and their VA improved significantly and was maintained for 10 years. Uveitis recurred in one-half of the patients, but visual acuity did not differ significantly from the patients without recurrence.
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Affiliation(s)
- Masaru Takeuchi
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan,*Correspondence: Masaru Takeuchi,
| | - Yoshihiko Usui
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Kenichi Namba
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroshi Keino
- Department of Ophthalmology, Kyorin University School of Medicine, Mitaka, Japan
| | - Masaki Takeuchi
- Department of Ophthalmology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiroshi Takase
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koju Kamoi
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keitaro Hase
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takako Ito
- Department of Ophthalmology, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Kei Nakai
- Department of Ophthalmology, Yodogawa Christian Hospital, Osaka, Japan
| | - Kazuichi Maruyama
- Department of Vision Informatics, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Eri Kobayashi
- Department of Ophthalmology, Nippon Medical School, Tokyo, Japan
| | - Hisashi Mashimo
- Department of Ophthalmology, Japan Community Health Care Organization Hospital, Osaka, Japan
| | - Tomohito Sato
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
| | - Nobuyuki Ohguro
- Department of Ophthalmology, Japan Community Health Care Organization Hospital, Osaka, Japan
| | - Junko Hori
- Department of Ophthalmology, Nippon Medical School, Tokyo, Japan
| | - Annabelle A. Okada
- Department of Ophthalmology, Kyorin University School of Medicine, Mitaka, Japan
| | - Koh-hei Sonoda
- Department of Ophthalmology, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiroshi Goto
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
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Yamana S, Hasegawa E, Takeda A, Yawata N, Sonoda KH. Long-term outcomes of infliximab in patients with Behçet's disease-associated uveitis. Int Ophthalmol 2022; 43:937-944. [PMID: 36057758 DOI: 10.1007/s10792-022-02495-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 08/20/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate long-term outcomes of infliximab (IFX) treatment in patients with Behçet's disease (BD)-associated uveitis. PATIENTS AND METHODS We retrospectively analyzed the cases of patients with BD-associated uveitis treated with IFX for > 5 years. We compared the numbers of ocular inflammatory attacks, ocular disease activities, and visual acuity before and after the initiation of IFX treatment. RESULTS The 24 patients were 20 men and 4 women. Their mean age at the initiation of IFX treatment was 37.3 ± 9.2 years. The mean term from the initiation of IFX treatment was 10.3 ± 2.4 years. The average number of ocular inflammatory attacks was 5.4 ± 2.1 per 12 months before the IFX treatment and significantly lower at 0.83 ± 0.96 per 12 months after the initiation of IFX treatment (p < 0.05). We used a scoring system for BD-associated uveitis named the Behçet's disease ocular attack score 24 (BOS24) to estimate the changes in ocular disease activities between before and after initiation of IFX treatment. The average score decreased significantly from 7.58 ± 2.77 to 2.55 ± 2.74 after the initiation of IFX treatment (p < 0.05). Even after > 5 years of the treatment, both the number of ocular attacks and the BOS24 score kept decreasing. The visual acuity in 42 of 48 eyes (24 patients) was improved or maintained. CONCLUSIONS IFX was effective for controlling ocular inflammatory attacks and diminishing ocular disease activities in patients with BD-associated uveitis, and it maintained the patients' visual acuity.
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Affiliation(s)
- Satoshi Yamana
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Eiichi Hasegawa
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Atsunobu Takeda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Nobuyo Yawata
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Koh-Hei Sonoda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Alizadegan F, Yalcinbayir O, Ucan Gunduz G, Pehlivan Y. Infliximab therapy in Behçet's uveitis. J Fr Ophtalmol 2022; 45:1036-1041. [DOI: 10.1016/j.jfo.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 03/26/2022] [Accepted: 04/05/2022] [Indexed: 10/14/2022]
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Bassi A, Krance SH, Pucchio A, Pur DR, Miranda RN, Felfeli T. The Application of Artificial Intelligence in the Analysis of Biomarkers for Diagnosis and Management of Uveitis and Uveal Melanoma: A Systematic Review. Clin Ophthalmol 2022; 16:2895-2908. [PMID: 36065357 PMCID: PMC9440710 DOI: 10.2147/opth.s377358] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/16/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aims to identify the available literature describing the utilization of artificial intelligence (AI) as a clinical tool in uveal diseases. Methods A comprehensive literature search was conducted in 5 electronic databases, finding studies relating to AI and uveal diseases. Results After screening 10,258 studies,18 studies met the inclusion criteria. Uveal melanoma (44%) and uveitis (56%) were the two uveal diseases examined. Ten studies (56%) used complex AI, while 13 studies (72%) used regression methods. Lactate dehydrogenase (LDH), found in 50% of studies concerning uveal melanoma, was the only biomarker that overlapped in multiple studies. However, 94% of studies highlighted that the biomarkers of interest were significant. Conclusion This study highlights the value of using complex and simple AI tools as a clinical tool in uveal diseases. Particularly, complex AI methods can be used to weigh the merit of significant biomarkers, such as LDH, in order to create staging tools and predict treatment outcomes.
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Affiliation(s)
- Arshpreet Bassi
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Saffire H Krance
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Aidan Pucchio
- School of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Daiana R Pur
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Rafael N Miranda
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada
- The Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Tina Felfeli
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada
- The Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ontario, Canada
- Correspondence: Tina Felfeli, Department of Ophthalmology and Visual Sciences, University of Toronto, 340 College Street, Suite 400, Toronto, ON M5T 3A9, Canada, Fax +416-978-4590, Email
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Horiguchi N, Kamoi K, Horie S, Iwasaki Y, Kurozumi-Karube H, Takase H, Ohno-Matsui K. A 10-year follow-up of infliximab monotherapy for refractory uveitis in Behçet's syndrome. Sci Rep 2020; 10:22227. [PMID: 33335139 PMCID: PMC7747559 DOI: 10.1038/s41598-020-78718-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/27/2020] [Indexed: 12/14/2022] Open
Abstract
Infliximab (IFX) was the first biologic introduced for refractory uveitis treatment in Behçet’s syndrome (BS). However, there have been few reports on the safety and efficacy of IFX monotherapy over follow-up periods of more than 10 years. This retrospective study evaluated the 10-year safety and efficacy of IFX monotherapy compared to IFX combination therapies with colchicine or corticosteroid for refractory uveitis in BS patients. Monotherapy was performed in 30 eyes of 16 patients while combination therapies were performed in 20 eyes of 11 patients. Continuation of IFX occurred in 70.3% of enrolled patients for 10 years without any significant difference noted in the retention rate between the monotherapy and combination therapies (p = 0.86). Reduction of ocular inflammatory attacks and improvement of best corrected visual acuity occurred in the monotherapy group after 10 years, which was equivalent to that for the combination therapies. Although adverse events (AEs) or therapy discontinuation occurred during the initial 5 years in both therapies, no AEs were observed for either therapy after 6 years. Our results suggested that IFX monotherapy proved to be effective and not inferior to combination therapies over a 10-year follow-up. Although loss of response and AEs may be noticed during the initial 5-year period, a safe and effective continuation can be expected thereafter.
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Affiliation(s)
- Noe Horiguchi
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.,Department of Ophthalmology, Nagano Prefectural Federation of Agricultural Cooperatives for Health and Welfare, Saku General Hospital, Nagano, Japan
| | - Koju Kamoi
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Shintaro Horie
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Yuko Iwasaki
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Hisako Kurozumi-Karube
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Hiroshi Takase
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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Tugal-Tutkun I, Çakar Özdal P. Behçet's disease uveitis: is there a need for new emerging drugs? Expert Opin Emerg Drugs 2020; 25:531-547. [PMID: 33147420 DOI: 10.1080/14728214.2020.1847271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: Behçet's disease uveitis (BDU) is a potentially blinding disorder. Systemic treatment with disease-modifying anti-rheumatic drugs (DMARDs) is mandatory in patients with intraocular inflammation involving the posterior segment of the eye. Areas covered: This article discusses existing systemic treatment with corticosteroids and conventional and biologic DMARDs as well as adjunctive local therapy in BDU. An overview is provided for a wide range of biologic DMARDs that have shown promise or investigated in clinical trials. Most recently introduced biologic DMARDs and targeted synthetic DMARDs are also reviewed for their potential in the treatment of BDU. Expert opinion: The prognosis of patients with BDU has remarkably improved after the introduction of biologic DMARDs. An expanding therapeutic armamentarium will allow treatment of most refractory cases. The ultimate goal is to provide drug-free remission with preservation of 20/20 vision.
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Affiliation(s)
- Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University , Istanbul, Turkey
| | - Pinar Çakar Özdal
- Department of Ophthalmology, University of Health Sciences, Ulucanlar Eye Education and Research Hospital , Ankara, Turkey
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Drug Retention Rate and Causes of Discontinuation of Adalimumab in Uveitis. Ophthalmology 2020; 127:814-825. [DOI: 10.1016/j.ophtha.2019.11.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/11/2019] [Accepted: 11/25/2019] [Indexed: 12/16/2022] Open
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12
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Long-Term Outcomes of Behçet's Syndrome-Related Uveitis: A Monocentric Italian Experience. Mediators Inflamm 2020; 2020:6872402. [PMID: 32508524 PMCID: PMC7245671 DOI: 10.1155/2020/6872402] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/08/2020] [Accepted: 04/28/2020] [Indexed: 12/20/2022] Open
Abstract
Objectives To examine demographic and clinical characteristics and long-term visual outcome in a cohort of Italian patients affected by Behçet's uveitis (BU). Materials and Methods Retrospective chart review of 47 patients with BU attending our unit between January 2018 and December 2019. Ophthalmologic manifestations, best-corrected visual acuity (BCVA), fluoroangiography and optical coherence tomography findings, and ocular complications were recorded. Predictive factors of a poor visual outcome and long-term complications were also investigated. Results Forty-seven patients (23 males and 24 females) for a total of 84 eyes were enrolled. Uveitis was bilateral in 37 (78.7%) patients with panuveitis being the most frequent anatomical pattern (40 out of 84 eyes), whereas 27 eyes presented a posterior uveitis. Isolated anterior uveitis was detected in 16 eyes. A significant improvement of median BCVA between baseline and last follow-up values was detected (p = 0.042). A higher risk of poor visual prognosis was observed in patients with uveitis duration greater than 15 years (p = 0.019). A significant resolution of retinal vasculitis was detected between baseline and last follow-up evaluation (p < 0.0001) whereas the mean ± SD macular thickness did not decrease significantly between baseline (376.00 ± 97.45 μm) and last follow-up evaluation (338.08 ± 55.81 μm). Forty-two eyes developed 57 complications during the disease course. Cataract was the most frequent (n = 12), followed by epiretinal membranes (n = 11) and cystoid macular edema (n = 6). The following variables were identified as predictors of long-term complications: human leukocyte antigen- (HLA-) B51 (p = 0.006), panuveitis (p = 0.037), and a uveitis duration of more than 15 years (p = 0.049). Conclusions In Italian patients, BU typically arises in the third decade and predominantly manifests as a bilateral posterior uveitis or panuveitis. Its duration is associated with a poor visual prognosis. Uveitis duration, the presence of HLA-B51, and panuveitis are predictors of long-term structural complications, thus representing main drivers in the treatment decision-making.
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13
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Valenzuela RA, Flores I, Urrutia B, Fuentes F, Sabat PE, Llanos C, Cuitino L, Urzua CA. New Pharmacological Strategies for the Treatment of Non-Infectious Uveitis. A Minireview. Front Pharmacol 2020; 11:655. [PMID: 32508634 PMCID: PMC7250389 DOI: 10.3389/fphar.2020.00655] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/22/2020] [Indexed: 12/14/2022] Open
Abstract
Non-infectious uveitis (NIU) is a group of disorders characterized by intraocular inflammation at different levels of the eye. NIU is a leading cause of irreversible blindness in working-age population in the developed world. The goal of uveitis treatment is to control inflammation, prevent recurrences, and preserve vision, as well as minimize the adverse effects of medications. Currently, the standard of care for NIU includes the administration of corticosteroids (CS) as first-line agents, but in some cases a more aggressive therapy is required. This includes synthetic immunosuppressants, such as antimetabolites (methotrexate, mycophenolate mofetil, and azathioprine), calcineurinic inhibitors (cyclosporine, tacrolimus), and alkylating agents (cyclophosphamide, chlorambucil). In those patients who become intolerant or refractory to CS and conventional immunosuppressive treatment, biologic agents have arisen as an effective therapy. Among the most evaluated treatments, TNF-α inhibitors, IL blockers, and anti-CD20 therapy have emerged. In this regard, anti-TNF agents (infliximab and adalimumab) have shown the strongest results in terms of favorable outcomes. In this review, we discuss latest evidence concerning to the effectiveness of biologic therapy, and present new therapeutic approaches directed against immune components as potential novel therapies for NIU.
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Affiliation(s)
- Rodrigo A Valenzuela
- Laboratory of Ocular and Systemic Autoimmune Diseases, Faculty of Medicine, University of Chile, Santiago, Chile.,Department of Chemical and Biological Sciences, Faculty of Health, Universidad Bernardo O Higgins, Santiago, Chile
| | - Iván Flores
- Laboratory of Ocular and Systemic Autoimmune Diseases, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Beatriz Urrutia
- Rheumatology Service, Department of Medicine, Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Francisca Fuentes
- Laboratory of Ocular and Systemic Autoimmune Diseases, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Pablo E Sabat
- Department of Ophthalmology, University of Chile, Santiago, Chile.,Department of Ophthalmology, Clínica las Condes, Santiago, Chile
| | - Carolina Llanos
- Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Loreto Cuitino
- Laboratory of Ocular and Systemic Autoimmune Diseases, Faculty of Medicine, University of Chile, Santiago, Chile.,Servicio de Oftalmología, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Cristhian A Urzua
- Laboratory of Ocular and Systemic Autoimmune Diseases, Faculty of Medicine, University of Chile, Santiago, Chile.,Department of Ophthalmology, University of Chile, Santiago, Chile.,Faculty of Medicine, Clinica Alemana-Universidad del Desarrollo, Santiago, Chile
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14
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Silvestri E, Bitossi A, Bettiol A, Emmi G, Urban ML, Mattioli I, Di Scala G, Bacherini D, Lopalco G, Venerito V, Iannone F, Vitale A, Tosi GM, Rizzo S, Fabiani C, Cantarini L, Virgili G, Vannozzi L, Prisco D. Adalimumab effectively controls both anterior and posterior noninfectious uveitis associated with systemic inflammatory diseases: focus on Behçet's syndrome. Inflammopharmacology 2020; 28:711-718. [PMID: 32157555 DOI: 10.1007/s10787-020-00697-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 02/27/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND To compare the efficacy of Adalimumab (ADA) in noninfectious anterior uveitis (AU) and posterior segment (PS) involvement, associated with different conditions, with a focus on Behçet's syndrome (BS). METHODS In this retrospective, multicenter post-hoc study, we evaluated the efficacy of ADA in terms of ocular control and relapses in 96 patients with AU and PS uveitis, either idiopathic (IU) or associated with BS or with other systemic disorders (OSD) (Juvenile Idiopathic Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis, Vogt-Koyanagi-Harada, Inflammatory Bowel Disease), followed in three tertiary referral centers. RESULTS Ninety-six patients (45 AU; 51 PS uveitis) were included. Eleven had IU, 58 BS, and 27 OSD. All patients with AU achieved complete long-term ocular control. In PS uveitis, 89%, 67% and 100% of patients with BS, IU and OSD achieved ocular control at the last follow-up (> 12 months), respectively. The lowest ocular relapse rate occurred in patients with AU with BS (1/13) or IU (0/2). ADA accounted for long-term disease control, and no predictors of ocular control and relapse were identified; particularly, ocular relapses seemed not related to systemic ones. Macular edema resolved in 75% and 67% of PS uveitis with BS and IU, respectively. CONCLUSIONS ADA controls both anterior and posterior uveitis, with an efficacy similar in IU, BS and OSD patients. In BS, the efficacy of ADA seems to be independent of demographic and clinical characteristics, and ocular relapses mostly occurred independently from systemic ones. Based on our results, ADA may represent a valid alternative in anterior refractory uveitis.
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Affiliation(s)
- Elena Silvestri
- Department of Experimental and Clinical Medicine, University of Firenze, 50134, Florence, Italy
| | - Alice Bitossi
- Department of Surgery and Translational Medicine, Eye Clinic, University of Firenze, 50134, Florence, Italy
| | - Alessandra Bettiol
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Firenze, 50139, Florence, Italy.
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, 50134, Florence, Italy
| | - Maria Letizia Urban
- Department of Experimental and Clinical Medicine, University of Firenze, 50134, Florence, Italy
| | - Irene Mattioli
- Department of Experimental and Clinical Medicine, University of Firenze, 50134, Florence, Italy
| | - Gerardo Di Scala
- Department of Experimental and Clinical Medicine, University of Firenze, 50134, Florence, Italy
| | - Daniela Bacherini
- Department of Surgery and Translational Medicine, Eye Clinic, University of Firenze, 50134, Florence, Italy
| | - Giuseppe Lopalco
- Department of Emergency and Organ Transplantation (DETO), Rheumatology Unit, University of Bari, 70121, Bari, Italy
| | - Vincenzo Venerito
- Department of Emergency and Organ Transplantation (DETO), Rheumatology Unit, University of Bari, 70121, Bari, Italy
| | - Florenzo Iannone
- Department of Emergency and Organ Transplantation (DETO), Rheumatology Unit, University of Bari, 70121, Bari, Italy
| | - Antonio Vitale
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, 53100, Siena, Italy
| | - Gian Marco Tosi
- Ophthalmology Unit of the Department of Medicine, Surgery and Neuroscience, University of Siena, 53100, Siena, Italy
| | - Stanislao Rizzo
- Ophtalmology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Claudia Fabiani
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, 53100, Siena, Italy
| | - Luca Cantarini
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, 53100, Siena, Italy
| | - Gianni Virgili
- Department of Surgery and Translational Medicine, Eye Clinic, University of Firenze, 50134, Florence, Italy
| | - Lorenzo Vannozzi
- Department of Surgery and Translational Medicine, Eye Clinic, University of Firenze, 50134, Florence, Italy
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Firenze, 50134, Florence, Italy
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15
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Mumcu G, Yay M, Aksoy A, Taş MN, Armağan B, Sarı A, Bozca BC, Tekgöz E, Karadağ DT, Badak SÖ, Tecer D, Bes C, Şahin A, Erken E, Cefle A, Çınar M, Yılmaz S, Karaçaylı Ü, Alpsoy E, Şenel S, Yaşar Bilge Ş, Kaşifoğlu T, Karadağ Ö, Aksu K, Keser G, Alibaz-Öner F, İnanç N, Ergun T, Direskeneli H. Predictive factors for work-day loss in Behçet's syndrome: A multi-center study. Int J Rheum Dis 2019; 23:240-246. [PMID: 31858715 DOI: 10.1111/1756-185x.13771] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of this multi-center study was to assess predictive factors for work-day loss as an indirect cost element in Behçet's syndrome (BS). METHODS In this cross-sectional, multi-center study, 834 BS patients (F/M: 441/393, age mean: 38.4 ± 10.9 years) were included. Data were collected by a questionnaire regarding treatment protocols, disease duration, smoking pattern, frequency of medical visits during the previous year and self-reported work-day loss during the previous year. RESULTS Work-day loss was observed in 16.2% of patients (M/F: 103/32). The percentages of being a smoker (81.8%), using immunosuppressive (IS) medications (82%), and having disease duration <5 years (74%) were higher in male patients with work-day loss (P < .05). The majority of males (90.9%) had more than four clinic visits during the previous year. Moreover, the mean work-day loss (30.8 ± 57.7 days) was higher in patients with vascular involvement (56.1 ± 85.9) than those without (26.4 ± 50.6 days) (P = .046). In addition, increased frequency of ocular involvement (25.9%) was also observed in patients with work-day loss compared to others (8.6%) (P = .059). CONCLUSION Work-day loss was associated with both vascular and ocular involvement. Close associations were observed among male gender, early period of the disease, frequent medical visits, being a smoker and treatment with IS medications in patients with work-day loss.
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Affiliation(s)
- Gonca Mumcu
- Faculty of Health Sciences, Marmara University, Istanbul, Turkey
| | - Meral Yay
- Department of Statistics, Mimar Sinan Fine Arts University, Istanbul, Turkey
| | - Aysun Aksoy
- Division of Rheumatology, Medical School, Marmara University, Istanbul, Turkey
| | - Mehmet Nedim Taş
- Division of Rheumatology, Medical School, Ege University, Izmir, Turkey
| | - Berkan Armağan
- Division of Rheumatology, Medical School, Hacettepe University, Ankara, Turkey
| | - Alper Sarı
- Division of Rheumatology, Medical School, Hacettepe University, Ankara, Turkey
| | - Burçin Cansu Bozca
- Dermatology Department, Medical School, Akdeniz University, Antalya, Turkey
| | - Emre Tekgöz
- Gulhane Medical Faculty, Division of Rheumatology, Gulhane Education and Research Hospital, Ankara, Turkey
| | - Duygu Temiz Karadağ
- Division of Rheumatology, Medical School, Kocaeli University, Kocaeli, Turkey
| | - Suade Özlem Badak
- Division of Rheumatology, Medical School, Cukurova University, Adana, Turkey
| | - Duygu Tecer
- Şanlıurfa Mehmet Akif İnan Education and Research Hospital, Sanlıurfa, Turkey
| | - Cemal Bes
- Rheumatology Clinic, Istanbul Bakırköy Dr.Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Ali Şahin
- Division of Rheumatology, Medical School, Cumhuriyet University, Sivas, Turkey
| | - Eren Erken
- Division of Rheumatology, Medical School, Cukurova University, Adana, Turkey
| | - Ayse Cefle
- Division of Rheumatology, Medical School, Kocaeli University, Kocaeli, Turkey
| | - Muhammet Çınar
- Gulhane Medical Faculty, Division of Rheumatology, Gulhane Education and Research Hospital, Ankara, Turkey
| | - Sedat Yılmaz
- Gulhane Medical Faculty, Division of Rheumatology, Gulhane Education and Research Hospital, Ankara, Turkey
| | - Ümit Karaçaylı
- Gulhane Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey
| | - Erkan Alpsoy
- Dermatology Department, Medical School, Akdeniz University, Antalya, Turkey
| | - Soner Şenel
- Division of Rheumatology, Medical School, Erciyes University, Kayseri, Turkey
| | - Şule Yaşar Bilge
- Division of Rheumatology, Medical School, Osmangazi University, Eskisehir, Turkey
| | - Timuçin Kaşifoğlu
- Division of Rheumatology, Medical School, Osmangazi University, Eskisehir, Turkey
| | - Ömer Karadağ
- Division of Rheumatology, Medical School, Hacettepe University, Ankara, Turkey
| | - Kenan Aksu
- Division of Rheumatology, Medical School, Ege University, Izmir, Turkey
| | - Gökhan Keser
- Division of Rheumatology, Medical School, Ege University, Izmir, Turkey
| | - Fatma Alibaz-Öner
- Division of Rheumatology, Medical School, Marmara University, Istanbul, Turkey
| | - Nevsun İnanç
- Division of Rheumatology, Medical School, Marmara University, Istanbul, Turkey
| | - Tülin Ergun
- Dermatology Department, Medical School, Marmara University, Istanbul, Turkey
| | - Haner Direskeneli
- Division of Rheumatology, Medical School, Marmara University, Istanbul, Turkey
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16
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Bettiol A, Hatemi G, Vannozzi L, Barilaro A, Prisco D, Emmi G. Treating the Different Phenotypes of Behçet's Syndrome. Front Immunol 2019; 10:2830. [PMID: 31921115 PMCID: PMC6915087 DOI: 10.3389/fimmu.2019.02830] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/18/2019] [Indexed: 12/13/2022] Open
Abstract
Behçet's syndrome (BS) is a multisystemic vasculitis, characterized by different clinical involvements, including mucocutaneous, ocular, vascular, neurological, and gastrointestinal manifestations. Based on this heterogeneity, BS can be hardly considered as a single clinical entity. Growing evidence supports that, within BS, different phenotypes, characterized by clusters of co-existing involvements, can be distinguished. Namely, three major BS phenotypes have been reported: (a) the mucocutaneous and articular phenotype, (b) the extra-parenchymal neurological and peripheral vascular phenotype, and (c) the parenchymal neurological and ocular phenotype. To date, guidelines for the management of BS have been focused on the pharmacological treatment of each specific BS manifestation. However, tailoring the treatments on patient's specific phenotype, rather than on single disease manifestation, could represent a valid strategy for a personalized therapeutic approach to BS. In the present literature review, we summarize current evidence on the pharmacological treatments for the first-, second-, and third-line treatment of the major BS phenotypes.
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Affiliation(s)
- Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Gulen Hatemi
- Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Lorenzo Vannozzi
- Eye Clinic, Careggi Teaching Hospital, University of Florence, Florence, Italy
| | - Alessandro Barilaro
- Department of Neurology 2 and Multiple Sclerosis Regional Referral Centre, Careggi University Hospital, Florence, Italy
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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17
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Emmi G, Prisco D. Behçet's syndrome: focus on pathogenetic background, clinical phenotypes and specific treatments. Intern Emerg Med 2019; 14:639-643. [PMID: 31317313 DOI: 10.1007/s11739-019-02154-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 07/10/2019] [Indexed: 01/12/2023]
Affiliation(s)
- Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, Largo Brambilla 3, 50134, Florence, Italy.
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Firenze, Largo Brambilla 3, 50134, Florence, Italy
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18
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Emmi G, Bettiol A, Silvestri E, Di Scala G, Becatti M, Fiorillo C, Prisco D. Vascular Behçet's syndrome: an update. Intern Emerg Med 2019; 14:645-652. [PMID: 30499073 DOI: 10.1007/s11739-018-1991-y] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 11/20/2018] [Indexed: 12/20/2022]
Abstract
Behçet's syndrome (BS) is a complex vasculitis, characterised by peculiar histological, pathogenetic and clinical features. Superficial venous thrombosis (SVT) and deep vein thrombosis (DVT) are the most frequent vascular involvements, affecting altogether 15-40% of BS patients. Atypical thrombosis is also an important clinical feature of BS, involving the vascular districts of the inferior and superior vena cava, suprahepatic veins with Budd-Chiari syndrome, portal vein, cerebral sinuses and right ventricle. On the other hand, arterial involvement, although affecting only 3-5% of patients, represents a unique feature of BS, with aneurysms potentially affecting peripheral, visceral and pulmonary arteries. Vascular events in BS are promoted by inflammation, with neutrophils playing a key role in the pathogenesis of thrombotic events; in turn, coagulative components such as fibrinogen, thrombin, factor Xa and factor VIIa amplify the inflammatory cascade. Understanding the contribution of inflammatory and coagulation components in the pathogenesis of BS vascular events is crucial to define the most effective therapeutic strategy. Control of vascular thrombosis is achieved with immunosuppressants drugs rather than anticoagulants. In particular, use of azathioprine and cyclosporine in association with low-dose corticosteroids should be considered in DVT and SVT cases, while treatment with cyclophosphamide together with anti-TNF-α agents can be effectively used in arterial involvement. More recently, the anti-TNF-α drugs have also been reported as a valid alternative for the treatment also of venous events, especially DVT. An exception to the use of anticoagulant in BS could be represented by cerebral veins thrombosis. In this review, we will depict the main characteristics of the vascular involvement in BS, briefly describing histological and pathogenetic features, while focusing on the clinical and therapeutical approaches of the vascular manifestations of BS.
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Affiliation(s)
- Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy.
| | - Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Firenze, Firenze, Italy
| | - Elena Silvestri
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - Gerardo Di Scala
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - Matteo Becatti
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Firenze, Firenze, Italy
| | - Claudia Fiorillo
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Firenze, Firenze, Italy
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
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19
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Adalimumab Accounts for Long-Term Control of Noninfectious Uveitis Also in the Absence of Concomitant DMARD Treatment: A Multicenter Retrospective Study. Mediators Inflamm 2019; 2019:1623847. [PMID: 30881221 PMCID: PMC6387715 DOI: 10.1155/2019/1623847] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/01/2019] [Indexed: 12/12/2022] Open
Abstract
Objective This study was aimed at assessing the long-term ocular control of adalimumab (ADA) in a large real-world population with noninfectious primary or secondary uveitis, focusing on the steroid-sparing effect and on disease-modifying antirheumatic drug (DMARD) cotreatment. Methods In this retrospective, multicenter study, the efficacy of ADA was evaluated in terms of ocular control, changes in best-corrected visual acuity (BCVA), corticosteroid-sparing effect, and drug retention rate, overall and stratified according to DMARD cotreatment. Results 106 patients were included. 88.7% had an associated systemic disease. After 6 and 12 months, proportions of patients with effective ocular control were 83.7% and 83.3%, respectively. At last the follow-up, 94.6% of patients had satisfactory ocular control. No difference in terms of ocular control at all time points emerged among patients starting ADA for ocular vs. systemic involvements. Patients with poor baseline BCVA remained stable or improved, while those with good BCVA hardly worsened. At 6 and 12 months, the median dose of prednisone significantly reduced to 5 mg/day (0-5) and 2.5 mg/day (0-5) (p < 0.001). Over a median follow-up of 36 months, 38 subjects discontinued ADA treatment. Mild to moderate side effects were reported in 7 patients (6.6%). ADA ocular control, corticosteroid-sparing effect, and drug retention rate were not influenced by the concomitant use of DMARDs. Conclusion The long-term ocular control of ADA in noninfectious primary or secondary uveitis is confirmed, also for BCVA preservation. Concomitant use of DMARDs does not provide additional benefits to ADA alone in terms of ocular control, steroid spare, and drug retention rate.
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20
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Becatti M, Emmi G, Bettiol A, Silvestri E, Di Scala G, Taddei N, Prisco D, Fiorillo C. Behçet's syndrome as a tool to dissect the mechanisms of thrombo-inflammation: clinical and pathogenetic aspects. Clin Exp Immunol 2018; 195:322-333. [PMID: 30472725 DOI: 10.1111/cei.13243] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2018] [Indexed: 01/01/2023] Open
Abstract
Behçet's syndrome (BS) is a complex disease with different organ involvement. The vascular one is the most intriguing, considering the existence of a specific group of patients suffering from recurrent vascular events involving the venous and, more rarely, the arterial vessels. Several clinical clues suggest the inflammatory nature of thrombosis in BS, especially of the venous involvement, thus BS is considered a model of inflammation-induced thrombosis. Unique among other inflammatory conditions, venous involvement (together with the arterial one) is currently treated with immunosuppressants, rather than with anti-coagulants. Although many in-vitro studies have suggested the different roles of the multiple players involved in clot formation, in-vivo models are crucial to study this process in a physiological context. At present, no clear mechanisms describing the pathophysiology of thrombo-inflammation in BS exist. Recently, we focused our attention on BS patients as a human in-vivo model of inflammation-induced thrombosis to investigate a new mechanism of clot formation. Indeed, fibrinogen displays a critical role not only in inflammatory processes, but also in clot formation, both in the fibrin network and in platelet aggregation. Reactive oxygen species (ROS)-derived modifications represent the main post-translational fibrinogen alterations responsible for structural and functional changes. Recent data have revealed that neutrophils (pivotal in the pathogenetic mechanisms leading to BS damage) promote fibrinogen oxidation and thrombus formation in BS. Altogether, these new findings may help understand the pathogenetic bases of inflammation-induced thrombosis and, more importantly, may suggest potential targets for innovative therapeutic approaches.
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Affiliation(s)
- M Becatti
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Firenze, Italy
| | - G Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, Italy
| | - A Bettiol
- Department of Experimental and Clinical Medicine, University of Firenze, Italy.,Department of Neurosciences, Psychology, Pharmacology and Child Health (NEUROFARBA), University of Firenze, Italy
| | - E Silvestri
- Department of Experimental and Clinical Medicine, University of Firenze, Italy
| | - G Di Scala
- Department of Experimental and Clinical Medicine, University of Firenze, Italy
| | - N Taddei
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Firenze, Italy
| | - D Prisco
- Department of Experimental and Clinical Medicine, University of Firenze, Italy
| | - C Fiorillo
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Firenze, Italy
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21
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Fabiani C, Vitale A, Rigante D, Emmi G, Bitossi A, Lopalco G, Sota J, Guerriero S, Orlando I, Gentileschi S, Iannone F, Frediani B, Galeazzi M, Vannozzi L, Tosi GM, Cantarini L. Comparative efficacy between adalimumab and infliximab in the treatment of non-infectious intermediate uveitis, posterior uveitis, and panuveitis: a retrospective observational study of 107 patients. Clin Rheumatol 2018; 38:407-415. [PMID: 30099655 DOI: 10.1007/s10067-018-4228-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 07/20/2018] [Indexed: 01/04/2023]
Abstract
To compare the efficacy of adalimumab (ADA) and infliximab (IFX) in patients with non-infectious intermediate uveitis, posterior uveitis, and panuveitis. Demographic, clinical, instrumental, and therapeutic data from patients enrolled were collected at the start of treatment, at 12-month follow-up, and at the last follow-up assessment. One hundred seven patients (46 females, 187 eyes) were enrolled, 66 (61.7%) treated with ADA and 41 (38.3%) with IFX. Bilateral involvement was observed in 80 cases. The mean follow-up was 26.45 ± 21.71 months for ADA patients and 56.60 ± 56.04 months for IFX patients. The overall decrease of uveitis frequency during the first 12 months of treatment was 66.7% in the IFX group and 84.2% in the ADA group, compared to the previous 12 months (p = 0.09). A significantly higher corticosteroid dosage was found among patients treated with ADA at the last follow-up visit (p = 0.008). The percentage of patients co-administered with corticosteroids was significantly higher among ADA patients both at the 12-month visit (p = 0.03) and at the last visit (p = 0.0004). The frequency of uveitic macular edema (UME) was significantly higher among patients treated with ADA compared to those treated with IFX at the 12-month assessment (p = 0.015) and at the last follow-up visit (p = 0.011); central macular thickness was significantly higher in ADA group compared to the IFX group at the last follow-up assessment (p = 0.04). ADA and IFX have shown a similar efficacy in controlling uveitis relapses, but IFX showed a more pronounced corticosteroid sparing effect and a significantly higher capacity in resolving UME compared to ADA.
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Affiliation(s)
- Claudia Fabiani
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
| | - Antonio Vitale
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico "Le Scotte", viale Bracci 1, 53100, Siena, Italy
| | - Donato Rigante
- Institute of Pediatrics, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli I.R.C.C.S, Rome, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alice Bitossi
- Department of Surgery and Translational Medicine, Eye Clinic, University of Florence, Florence, Italy
| | - Giuseppe Lopalco
- Interdisciplinary Department of Medicine, Rheumatology Unit, University of Bari, Bari, Italy
| | - Jurgen Sota
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico "Le Scotte", viale Bracci 1, 53100, Siena, Italy
| | - Silvana Guerriero
- Department of Ophthalmology and Otolaryngology, University of Bari, Bari, Italy
| | - Ida Orlando
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico "Le Scotte", viale Bracci 1, 53100, Siena, Italy
| | - Stefano Gentileschi
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico "Le Scotte", viale Bracci 1, 53100, Siena, Italy
| | - Florenzo Iannone
- Interdisciplinary Department of Medicine, Rheumatology Unit, University of Bari, Bari, Italy
| | - Bruno Frediani
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico "Le Scotte", viale Bracci 1, 53100, Siena, Italy
| | - Mauro Galeazzi
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico "Le Scotte", viale Bracci 1, 53100, Siena, Italy
| | - Lorenzo Vannozzi
- Department of Surgery and Translational Medicine, Eye Clinic, University of Florence, Florence, Italy
| | - Gian Marco Tosi
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Luca Cantarini
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico "Le Scotte", viale Bracci 1, 53100, Siena, Italy.
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